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Diskusi Topik Bahaya Rokok

Diskusi Topik Bahaya Rokok. Evan Regar 0906508024 Faradila Keiko 0906508062 Farah Asyuri Yasmin 0906552611 Hanifah Rahmani Nursanti 0906487814 Herliani Dwi Putri Halim 0906487820. ILUSTRASI KASUS.

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Diskusi Topik Bahaya Rokok

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  1. DiskusiTopikBahayaRokok Evan Regar 0906508024 Faradila Keiko 0906508062 Farah AsyuriYasmin 0906552611 HanifahRahmaniNursanti 0906487814 HerlianiDwiPutriHalim 0906487820

  2. ILUSTRASI KASUS • Seoranglaki-lakiberusia 56 tahundatangdengankeluhannyeridi dada kanan yang hilangtimbul, disertaidengansesaknapassejak 1 bulanlalu. Nyeridirasakansepertiditusukdanmenjalarhinggapunggungkanan. Pasienmerokok 10 batang per hariselamakuranglebih 30 tahun, dansudahberhentimerokoksejak 5 tahunlalu. Hasilpemeriksaanfisikparu: dada kanantertinggal, fremitusparukananmelemah, perkusiparukananatasredup, bunyivesikulerparukananmelemah. Fototoraksmenunjukkanadanyamassapadamediastinum superior. Pasiendidiagnosisadenocarcinomaparu.

  3. RokoksebagaiPermasalahanDunia

  4. Rokokdapatmembunuh 5,2 jutaorangdidunia. Setengahdariorangtersebutmenderitakankerparu. 260 orangmeninggalsetiapharinya... www.stcolmshigh.org

  5. Tembakau Membunuh: • Separuhpenggunanya • Hampir6 jutaorang/ tahun 5 jutaperokok & mantanperokok, >600.000 perokokpasif • 1 orangsetiap6 detik • 1 diantara 10 kematiandewasa • 22% populasidunia>15 tahun perokok • Total perokokdidunia satubiliar ASH. Smoking and cancer. Action on Smoking and Health; UK: March 2011

  6. Smoking: It’s not just lung cancer. Cancer Council Queensland: Queensland; 2009

  7. ROKOK

  8. IARC  merokokmenyebabkan 15 tipekanker • Kandungkemih • Sumsumtulang (leukimia myeloid) • Cervix • Colorectal • Ginjal • Laring • Hati • Paru • Mulut (bibirdanlidah) • Hidung • Esofagus • Ovarium • Pankreas • Faring • Abdomen ASH. Smoking and cancer. Action on Smoking and Health; UK: March 2011

  9. http://tocancer.com/wp-content/uploads/2011/08/c38.jpg http://images.medicinenet.com/images/Lung_8_01.gif

  10. KankerParu • Terseringdidunia • 1,61 jutakasusbaru, 1,38 kematian/tahun • 85-90% pasien perokokaktif/pasif • Risikokematianmeningkatseiringjumlahrokokperhari & durasimerokok • Merokoksejak 15 tahun mutasisel2x > sejakusia20 tahun • SCOTH: risikokankerparupadaperokokpasif> 20-30%. Padaanak 3x lipat. ASH. Smoking and cancer. Action on Smoking and Health; UK: March 2011

  11. PPOK • 80%  rokok • Pajananpekerjaan, polusiudara, perokokpasif • WHO: 210 jutaorangdidunia • Separuhperokok obstruksijalannapas • 10-20% perokok PPOK • Perokokpasifanak emfisemasaatdewasa ASH. Smoking and respiratory disease. Action on Smoking and Health; UK: February 2011.

  12. Lainnya • Pneumonia • perokokaktif& pasif faktorrisikoCAP • ~jumlahrokok yang dikonsumsipertahun. • Tuberkulosis • lebihseringterjadipadaperokok • kasuskambuhTB

  13. Lainnya • Asma • Perkembangan & eksaserbasiasmaanak &dewasa • Anak yang menderitaasmadenganorangtuaperokok eksaserbasiasma 2x lipat per tahun • Infeksisaluranpernapasanbawah: bronkhitis, pneumonia, bronkhiolitis (peningkatanrisiko 72% padaperokokpasif) • ASH. Smoking and respiratory disease. Action on Smoking and Health; UK: February 2011

  14. KandunganRokok

  15. http://www.edinboro.edu/departments/ghering/smoking_cessation.dothttp://www.edinboro.edu/departments/ghering/smoking_cessation.dot

  16. KandunganRokok • Nikotin • PAHs • Akrolein • Nitrosamin • Radioaktif • dll Kumar V, Abbas AK, Fausto N, Mitchell R. "Chapter 8: Environmental and Nutritional Diseases". Robbins Basic Pathology (8th ed.). Philadelphia: W.B. Saunders. p. 288, Figure 8-6

  17. Rokok mengiritasisalurannapas: • Produksimukus ↑ • Pergerakansilia ↓ • Leukositdanpergerakannyake lumen salurannapas↑ • Permeabilitasmukosasalurannapasterhadapalergen↑ BATUK

  18. Nikotin • Sebatangrokok: 1,2-2,9 mg nikotin. • 1 bungkusrokok/harimengabsorbsi 20-40 mg nikotin/hari meningkatkankadarnikotin plasma sekitar 23-35 ng/mL. • Peningkatankadarnikotinsecaraperlahanmenginduksiperasaanrileksdansedasi. • Nikotinmenstimulasicorticotropin-releasing factor (CRF) dihipotalamusmeningkatkankadarendorphin Rodgman A, Smith CJ, Perfetti TA. The composition of cigarette smoke: retrospective, with emphasis on polycyclic components. Human & Experimental Toxicologu (200) 19, 573-95.

  19. Nikotin • Kebiasaanmerokok • Nikotin aktivitasneurofisiologisdisistemdopaminmesolimbik nucleus akumbens (kayadopamin) • BekerjamelaluiNicotinic Acetylcholine Receptors(nAChRs)  terbanyak: subtipealpha-4 dan beta-2 • Mempengaruhiglutamate, GABA, asetilkolin, dopamine, norepinefrin, danserotonin Rodgman A, Smith CJ, Perfetti TA. The composition of cigarette smoke: retrospective, with emphasis on polycyclic components. Human & Experimental Toxicologu (200) 19, 573-95.

  20. Nikotin • Hambatenzim monoamine oksidase (MAO) metabolisme dopamine ikutterhambat kadardopamine tinggi perangsangannukleusakumbens. Rodgman A, Smith CJ, Perfetti TA. The composition of cigarette smoke: retrospective, with emphasis on polycyclic components. Human & Experimental Toxicologu (200) 19, 573-95.

  21. Environmental Tobacco Smoke

  22. Environmental Tobacco Smoke • ETS padaperokokpasif penyebab3000 kematianakibatkankerparu / tahun. • Padaanak-anak • infeksisalurannapasbagianbawah (bronchitis danpneumonia) • Memperburukkondisiasma faktorrisiko Murphy TD. Passive Smoking and Lung Disease. Medscape (Maret 2012). Diunduhdari: http://emedicine.medscape.com/article/1005579-overview#a0101

  23. Environmental Tobacco Smoke • Paparanasaprokokmenginduksiresponlokaldansistemik: • PeningkatanTNF-alpha, IL-5, monocytechemoattractant protein (MCP)-1, densitassubstansi P disepanjangepitelbronchial  batuk, peningkatanproduksimukus, peningkatanpremeabilitasmukosasalurannapas • Pajananasaprokokpadamasaperinatal jumlahsel mast, eosinofil, monosit, danlimfositpadaparu Murphy TD. Passive Smoking and Lung Disease. Medscape (Maret 2012). Diunduhdari: http://emedicine.medscape.com/article/1005579-overview#a0101

  24. MerokoksebagaiFaktorRisiko • Riwayatmerokok • Perokokaktif • Perokokpasif • Bekasperokok • Indeks brinkman (reratajmlbatang per harix lama merokokdlmtahun) • Ringan 0-200 • Sedang 200-600 • Berat >600 PDPI. Pedoman Diagnosis danPenatalaksanaan PPOK. 2003. Jakarta: PDPI; p. 3.

  25. BahayaRokokTerhadapPerokokPasif

  26. This exposure was estimated to have caused 379,000 deaths from heart disease, 165,000 from lower respiratory infections, 36,900 from asthma and 21,400 from lung cancer. (http://www.bbc.co.uk/news/health-11844169) SECOND HAND SMOKE

  27. coronary heart disease • heart attacks • angina (chest pain) • heart failure • strokes • chronic obstructive pulmonary disease (COPD) • pneumonia (inflammation of the lungs) • http://www.nhs.uk/chq/pages/2289.aspx?categoryid=53&subcategoryid=536 http://www.cdc.gov/vitalsigns/TobaccoUse/SecondhandSmoke/risk.html

  28. AnaksebagaiPerokokPasif • Sudden infant death syndrome (SIDS) – dua kali lipatpadaibu yang merokok, • Asma • Meningitis • Batukdanpilek • Infeksitelinga (otitis media) Anak yang dibesarkanolehorangtua yang merokok memilikikecenderungandua kali lipatuntukmerokokdikemudianhari. http://www.nhs.uk/chq/pages/2289.aspx?categoryid=53&subcategoryid=536

  29. EkivalensiPerokokPasif • kadarkarbonmonoksida yang samadenganperokokaktifapabilaterpajanasaprokok 1-2 jam • jumlahpartikelasap yang samadenganperokokaktifdalamsebelas jam, • kadarakrolein yang samadenganperokokaktifdalamtujuh jam, • kadarnikotindanhidrogensianida yang samadalam lima puluhjam. • Canadian Centre for Occupational Health and Safety. Environmental Tobacco Smoke (ETS): General Information and Health Effects. (18 Nov 2012). Diunduhdarihttp://www.ccohs.ca/ oshanswers/ psychosocial/ets_health.html

  30. PatologiAkibatRokok

  31. ResponsSelulerTerhadapRokok • Inflamasi • Apoptosis selular • Perubahanintraselular • Perubahanbiomolekular • Destruksimatriksekstraselular • Stresoskdiatif • Karsinogenesis Stinn W, Buettner A, Weiler H, Friedrichs B, Luetjen S, Overveld FV, et al. Lung inflammatory effects, tumorigenesis, and emphysema development in a long-term inhalation study with cigarette mainstream smoke in mice. Toxicology. (2012)

  32. ProsesPembentukanSpesiOksidatif http://www.pneumonologia.gr/articlefiles/20070509_7.pdf

  33. InflamasiAkibatRokok • Efeksiliotoksik • Peningkatanproduksimukusdanhipertrofi/hiperplasiakelenjarpenghasilmukus • Akumulasiselinflamasi • Kerusakanlnagsungpadaepitel (misal: asam, amonia, aldehida)  inflamasilokal Yoshida T, Tuder RM. Pathobiology of cigarette smoke-induced chronic obstructive pulmonary disease. Physiol Rev. 2007(87):1047-82 Behr J, Nowak D. Tobacco smoke and respiratory disease. [Internet] Cited: 2012 Nov 17. Available from: http://www.pneumonologia.gr/articlefiles/20070509_7.pdf

  34. Ketidakseimbangan Protease/Antiprotease • Protease: enzimpendegradasijaringan • Antiprotease: penghambat protease • Spesireaktifmeningkatkanaktivitas protease • Spesireaktifmendeaktivasiaktivitasantiprotease • Imbalans protease/antiprotease peningkatanaktivitas protease  kerusakanjaringan Behr J, Nowak D. Tobacco smoke and respiratory disease. [Internet] Cited: 2012 Nov 17. Available from: http://www.pneumonologia.gr/articlefiles/20070509_7.pdf

  35. Antioksidan • Alamiah: transferin, seruloplasmin, protein serum, laktoferin, taurin, glutation (GSH), enzim SOD dan Cat • Penelitianmenunjukkanpenurunankadar GSH signifikanpadaperokok meningkatkankemungkinanspesireaktifoksidan Behr J, Nowak D. Tobacco smoke and respiratory disease. [Internet] Cited: 2012 Nov 17. Available from: http://www.pneumonologia.gr/articlefiles/20070509_7.pdf

  36. http://www.pneumonologia.gr/articlefiles/20070509_7.pdf

  37. http://www.mynosmoking.com/my-no-smoking-pictures/stop-smoking-start-repairing.jpghttp://www.mynosmoking.com/my-no-smoking-pictures/stop-smoking-start-repairing.jpg

  38. Terimakasih

  39. DaftarPustaka • 1ASH. Smoking and cancer. Action on Smoking and Health; UK: March 2011 • 2ASH. Smoking and respiratory disease. Action on Smoking and Health; UK: February 2011. • 3Tanuwihardja RK, Susanto AD. RokokElektronik. J Respir Indo Vol. 32, No. 1, Januari 2012. 53-61. • 4Rodgman A, Smith CJ, Perfetti TA. The composition of cigarette smoke: retrospective, with emphasis on polycyclic components. Human & Experimental Toxicologu (200) 19, 573-95. • 5American Cancer Society. Smoking, Tobacco, and Health. Diunduhdari: http://www.cancer.org/acs/groups/cid/documents/webcontent/002974-pdf.pdf 17 Nov 2012 • 6PDPI. Pedoman Diagnosis danPenatalaksanaan PPOK. 2003. Jakarta: PDPI; p. 3. • 7Lande RG. Nicotine Addiction: Pathophysiology. Medscape (Juli 2012). Diunduhdarihttp://emedicine.medscape.com/article/287555-overview#a0104 • 8Murphy TD. Passive Smoking and Lung Disease. Medscape (Maret 2012). Diunduhdari: http://emedicine.medscape.com/article/1005579-overview#a0101 • 9Stinn W, Buettner A, Weiler H, Friedrichs B, Luetjen S, Overveld FV, et al. Lung inflammatory effects, tumorigenesis, and emphysema development in a long-term inhalation study with cigarette mainstream smoke in mice. Toxicology. (2012) • 10Yoshida T, Tuder RM. Pathobiology of cigarette smoke-induced chronic obstructive pulmonary disease. Physiol Rev. 2007(87):1047-82 • 11Behr J, Nowak D. Tobacco smoke and respiratory disease. [Internet] Cited: 2012 Nov 17. Available from: http://www.pneumonologia.gr/articlefiles/20070509_7.pdf • 12Canadian Centre for Occupational Health and Safety. Environmental Tobacco Smoke (ETS): General Information and Health Effects. (18 Nov 2012). Diunduhdarihttp://www.ccohs.ca/ oshanswers/ psychosocial/ets_health.html.

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